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American Society of Addiction Medicine
Public Policy Statement
On Repeal of the Uniform Accident and Sickness Policy
Provision Law (UPPL)
Background
Over the past 45 years, the insurance codes of 38 states have incorporated the Uniform
Accident and Sickness Policy Provision Law (UPPL) which includes the language:
“Intoxicants and Narcotics: The insurer shall not be liable for any loss sustained or
contracted in consequence of the insured’s being intoxicated or under the influence of
any narcotic unless administered on the advice of a physician.”
During the same period, four additional states have adopted provisional restrictions. These
restrictions enable insurers to deny payment for treatment of alcohol or other drug-related
injuries.
Injuries are the leading cause of death in individuals less than 40 years of age, the fourth
leading cause of overall mortality, and the number one cause of ER visits, with alcohol use
being the leading contributing factor to injuries (between 35-50% of injured patients treated in
ERs and trauma centers are under the influence of alcohol or other intoxicants). Reports
from the Centers for Disease Control and Prevention (CDC) and the National Highway Traffic
Safety Commission indicate that because of the UPPL, trauma surgeons and trauma centers
are less likely to screen patients for alcohol or other drug disorders because it threatens
reimbursement and trauma center financial viability in states where the UPPL is enforced.
The UPPL was promulgated as a Model Law by the National Association of Insurance
Commissioners (NAIC) in 1947, when treatment for alcohol and other drug disorders was
generally not available and regional trauma centers did not exist. Over 40 studies have
documented the effectiveness of brief alcohol interventions in health care settings, including
ERs and trauma centers, in reducing subsequent alcohol intake, DUIs, alcohol-related traffic
infractions, alcohol-related arrests, and injury-related hospital readmissions. ER screening
for alcohol problems is an evidence-based prevention strategy and is recommended by the
U.S. Department of Health and Human Services within Objective 26-5 (“Reduce alcoholrelated hospital emergency department visits”) of Healthy People 2010.
Public Policy Statement on Repeal of the Uniform Accident and Sickness Policy Provision Law (UPPL)
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A cost-benefit analysis conducted at the University of Texas Southwestern Medical School
and the University of Washington demonstrated that routine ER and trauma center alcohol
screening and intervention would result in an estimated three-year net national savings of
$1.82 billion in direct medical costs, all of which go to payers of health care (insurers, state
and federal governments). Direct medical costs are estimated to comprise only 15% of total
costs, with the balance attributable to property damage, lost wages and other losses. The
study found that nearly $4 in direct medical costs are saved for every dollar invested in ER
and trauma center screening and intervention.
A variety of federal, expert, public policy and advocacy groups now recommend routine ER
screening and intervention and have published reports recommending statutory repeal of the
UPPL, because it is a significant barrier to implementation of screening protocols. Currently,
fewer than 15% of injured patients in hospitals are screened for alcohol and other drug
disorders and referred for counseling. The National Conference of [state] Insurance
Legislators (NCOIL) also recommends that states should revise their UPPL statutes. In
recent years, 8 states have rescinded the provision, and others currently have similar
proposals before their state legislatures. The NAIC, the organization that drafted the UPPL
as a Model Law in 1947, recently passed a new Model that specifically prohibits insurance
companies from denying reimbursement on the basis of patient alcohol or other drug use.
This new model was adopted by the NAIC by unanimous vote.
Repeal of the original state UPPL codes will not increase insurance costs, because in those
jurisdictions where the UPPL is in force, physicians are simply not measuring and
documenting alcohol or other drug use. If the physician does not document alcohol use or
intoxication, it is rarely detectable by insurers through other means. Thus, insurers are
already paying for the vast majority of alcohol related injuries. However, the opportunity to
screen and refer patients with alcohol and other drug dependencies is missed when doctors
are not free to screen their patients due to provisions that may be contained in their insurance
contracts that contradict currently recommended best practice recommendations for
screening and intervention.
Recommendations
1. ASAM recommends that health insurance coverage for the provision of medical
services should be based on the medical necessity for providing care, not on the
circumstances under which an illness or injury arose, such as whether or not the
individual is under the influence of alcohol or other drugs when an injury or illness
occurs. (See ASAM Public Policy Statement on “Health Care Services for
Conditions Resulting from Patient Behaviors.”)
2. ASAM recommends that state and specialty medical societies and public health
associations initiate or increase their efforts to secure repeal of UPPL-related
insurance codes at the state level which, if in force, 1) allow for the denial of
insurance payments for the treatment of injuries sustained as a consequence of the
insured person being intoxicated due to alcohol or other drugs; and 2) therefore
serve as a major deterrent to screening and indicated referral to professional
Public Policy Statement on Repeal of the Uniform Accident and Sickness Policy Provision Law (UPPL)
3
treatment for alcohol and other drug use problems and disorders. Repeal will
rectify the unintended consequences of the antiquated UPPL statute, thereby aiding
people with alcohol and other drug disorders, reducing insurance costs by
reducing recidivism, and getting drunk drivers off the road, at no cost to the state,
to taxpayers, or to insurance companies.
Adopted by the Board of Directors of the American Society of Addiction Medicine July 2005
© Copyright 2005. American Society of Addiction Medicine, Inc. All rights reserved. Permission to make digital or hard
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Republication, systematic reproduction, posting in electronic form on servers, redistribution to lists, or other uses of this
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Excerpting any statement for any purpose requires specific written permission from the Society. Public Policy statements
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current position of ASAM on the topic addressed.
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